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4�1� APPLICATION FOR SANITATION PERMIT Permit No_ ---------I_--_------- 41 (Complete in Duplicate) Date Issued Application is hereby made to theSan"Joaquin Local Health District for 6 permit to consf'ruct and install the work herein described. , This application is made in compliance with County Ordinanc o. 4 9. A ------ -A ------------ _�-- ------- ------ -----I------------------------------- JOB ADDRESS AN�DPC -- ------- ---- ------ ---- ---------- -Q- one------------------------------------ Owner's Name---.._` -- -- ----- 0 -- - ----- ----- -- ----------- ---- --- - Address L --- ------------- ------ --------------------------- --- ----------- ---------- --- :�C, . - ------ ---------------------- V/ Contractor's Name--------------- Installation-will serve: Residence Apartment House [] Commercial El Trailer Court (] Motel 0. Other ❑ I �( baths _ Lot size ----- Vw ------------------ Number of living units: ___// Number of bedrooms _/_ Number' of ba- I i . -] t le// t. Water Supply. Public systorn Community systern ❑ Private [I ' Depth to Wafer Tab x i V - am ❑ Clay E] Adobe Hardpan I-] fo a depth of 3 feet:` Sand El - Gravel [I SandLoam oam El Cla Lo [] Character of soiii, CNo New Construction: Yes E] Previous Application Made [:]': YesNo FHA/VA: Yes E] No E] ' X' TYPE,OF INSTALLATIONAND SPECIFICATIONS: (No septic tank or'6essPool permitted if public sewer',is available within Zo0feet.) f ii�t n Distance from nearest well------------------Distance,from foundaon-------------------No. of c�ompa.rime Material------------------------------------------------ i rils' -Size---------- -----------------Liquid ,dep.th--------------------------Capacity-------------- -------- . ------------ - ---------- osa e1 Disitance from a' �'Ifouncl, ------------- sf well stance froM, 5tion ..__Distance to nearest lot line________________ �ne re -----------------Di " '* Number of lines:----------------------------------Length of eachllile------------- ---------------Width, of trench---------------------------------.- De rench--------------------------------- Type of filter material___________________ Depth of filter material----- .'X_koT6I length-----------__---------------------- I material_________________x: °Total length_______.___.-_._______---_------ Type Pit: t r m. undation---V Distance to nearest ------I--------------Distan -j62�_l---- ,distance to nearest lot line --"Size:,Diameter 4,�Pj ®� Dep h___ - - Number of pits-.....L-------------Lining materia ------ ------- ------------ IK Cesspool: Distance from nearest weil-----------------Distance from foundati-on ' -----------Linihq-material___________________------------------ EJ Size: Diameter------------------------- ------Depth-------------------------------1--_-----i------- ---Liquid Capacity----------------------------gals. Privy: Distance from nearest well--';-.,------------------- ----------------------Distance from 'nearest building--------------------_--------------- - -. ❑ Distance uilding------------------------------------------ Disfance to-nearest lot line---------------- ----------------------------------------------------------------------------------- --- -------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)--------------- ....i--------------------------- -------------------------------------- ---------------------------------------------------------------------------- � 1� �:-----------------------L-----------------------------------------------------------------------------------1:---------- -------------------------------------------------------- ----------------------------------- �-i - ------)----------------------- ------------------------------------------I-------------------------------------------------------------------- --------------------------------------------W--------------------------------- I . il n and that the work will be donelin accordance with San-.Joaquin County I hereby/6-H-ify thatfil hav re ar-ed this application ordinances, la S, "d-r s ands reguIajj4oni'tf the Joaquin Local Health District. - - ---------- --------------------------------- ---- --------------------------------------------- -- _ wner and/or Contractor) d _ -- ------ ------- (Signed),__ - ----- - - --------i----- (Tif le)---------- -- -------:--------------------------------------- By:_----------------------- ------- - -- - -- ---- ---------------------------------- n reverse side). FS, P,o (Plot plan, showing size of lot,- loc tion of system in' relation to ells, buildings, etc., can be placed o F,(N DEPARTMENT USE ONLY .:�= APPLICATIONACCEPTED BY------ ------ --- ---------1--- ----------------------------------------------- DAT�E__---------------------- --- --------------------------- REVIEWED -------------------------- REVIEWED BY.-------------I----) ------ ----------- -- -------------------------------------------------- DATE-------------- --------------------------------------- I---------------- ----------- 14 BUILDINGPERMIT ISSUED--------------=----- . . ............--------------------------------------- DATE---------V\_e�-------------------------------------------- 1.� --------------------------------- I----------------I—- -- .T.and/or recorri'meqDdIptions ------------------------ ------- ------------ 10 - - - - ------------------------- - -- --------------- -----------wm---- -------------- ------------------------------------------------------ -------------------------- ------- -----------------------Z%__--------------------------------------------------- ---------------------------------------- ---------------------A---------------------------------------------- ------------------------------- ------------------------------------------------------ Date_. ----------77.- -- ---------r-------------- NLF_1_NALINSPffT_16_W BY:____________ ,-- 1 4- ------------ S JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh,American Street 300 West Oak Street 132 Sycamore Street 1 814 North "C" Street Stockton -1, California IL,di, Califol' r,7l.a Manteca, California Tracy, California l ES-9-2M Revisea 1,57 F-P Co.